Yoga breathing exercises lower IOP in primary open-angle glaucoma
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Yogic pranayama and diaphragmatic breathing as an adjunct therapy significantly decreased IOP in patients with primary open-angle glaucoma, according to a prospective randomized trial.
“Considering the similarities between glaucoma pathogenesis and stress-associated changes, there is a possibility that IOP can be normalized if stress is counteracted by means of relaxation techniques,” Hemlata Udenia, MS, of the department of ophthalmology at All India Institute of Medical Sciences, and colleagues wrote in Journal of Glaucoma. “Among alternative and complementary therapies, yoga is widely used to improve quality of life.
“Relaxation techniques have been reported to reduce IOP and improve neuroendocrine regulation of the ciliary body and the production of aqueous humor,” they added.
The researchers randomized 90 patients with moderate-to-severe primary open-angle glaucoma 1:1 to either the yogic pranayama and diaphragmatic breathing (YPDB) group or the control group.
Participants were included if they were currently using eye drop medication, which they continued for the duration of the study. In addition to medication, the YPDB group practiced deep breathing techniques for 30 minutes every morning. This was done with an instructor for 4 weeks and at home for the remainder of the study period.
IOP was measured in both eyes at baseline and at 1-, 3- and 6-month follow-ups; four YPDB and five control patients did not complete all follow-ups.
In the control group, the mean IOP of the right eye significantly decreased from 19.51 mm Hg at enrollment to 15.76 mm Hg at 6 months. In the left eye, mean IOP significantly decreased from 19.32 mm Hg at enrollment to 15.32 mm Hg at 6 months.
The YPDB group also had significantly reduced mean IOP in both eyes over the course of the study: In the right eye, it decreased from 20.85 mm Hg to 14.90 mm Hg; in the left eye, it decreased from 20.30 mm Hg to 14.25 mm Hg.
However, within-group comparisons showed that only the YPDB group had significant reductions in mean IOP at 6 months, with 40 YPDB participants (89%) attaining IOP reduction greater than 28%.
There were no adverse events, and neither group had significant changes in OCT or visual field.
The lack of data for OCT and visual field function limited the study, Udenia and colleagues wrote. Other limitations included small sample size, once daily IOP measurement, assumptions about the effect of YPDB on circulating stress biomarkers and quality of life, and specificity to patients with moderate-to-severe glaucoma.
“These YPDB exercises can be recommended as an adjunctive therapy; however, our findings do not support it as a substitute for medications or treatment options such as eye drops,” the researchers wrote. “Further studies are needed to determine whether yogic breathing exercises could reduce or prevent vision loss progression or allow vision restoration.”
Perspective
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Can yoga breathing exercises be used to provide IOP lowering benefits? Currently, the only treatment options aimed at lowering IOP are through pharmacological or surgical means. Udenia and colleagues found that YPDB exercises can reduce IOP in primary open-angle glaucoma patients.
It is important to remember that not all yoga exercises are created equally. There are established reports of certain poses, specifically downward-facing dog, that result in acute elevations of IOP. In this study, the effects of regulated breathing via contraction and expansion of the diaphragm as well as deep inhalation and exhalation revealed evidence of IOP reduction. The proposed mechanism is via an increase in melatonin production and reduced sympathetic activity, leading to a decrease in aqueous humor secretion.
The study has numerous limitations including a small sample size, a homogenous population and uncontrolled variables including the type and dosing of medications used. Another limitation was the use of once daily IOP measurements, which is known to have a diurnal variation.
Yoga breathing exercises are not a substitute for glaucoma treatment, however they can be recommended as adjuvant therapy for additional IOP lowering benefits for patients. Further research is warranted to understand the long-term effectiveness of these exercises in glaucoma management.
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